Oral Motor Exercises to Help Speech in Toddlers and Preschoolers – Why Science Says They Don’t Work

Recently I’ve heard of mothers who are telling other mothers that they’d better be doing oral motor exercises at home with their kids and find SLPs who will do these with their kids to help their toddlers learn to speak more clearly. I wanted to let you all in on apparently what some SLPs aren’t telling you.

There’s a whole lot of research in the past few years that tell us that oral motor exercises DON’T work to help children learn to speak more clearly. Before all of you get fired up and start a campaign to write in to tell me how crazy I am, let’s take a look at what science says………..

In his ASHA presentation in November 2006, Dr. Gregory Lof, a PhD level speech-language pathologist from MGH Institute of Health Professions in Boston, titled his work, “Logic, Theory and Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sound Productions.”

In real words – he’s saying that common sense tells you that these exercises don’t work to make children speak more clearly, and then he cites a whole bunch of scientific studies that back him up.

For those of you who are really confused, he’s defined “non-speech oral motor exercises” as “any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities” and “a collection of non-speech methods and procedures that claim to influence tongue, lip, and jaw resting postures, increase strength, improve muscle tone, facilitate range of motion, and develop muscle control.”

Again, but in English please! He’s talking about all of those mouth “exercises” or “games” that SLPs tell you to do including blowing, tongue push ups, pucker-smile, tongue wags, big smile, tongue to nose to chin, cheek puffing, blowing kisses, and tongue curling.

Basically, he’s saying any “game” or “exercise” that you have your child do that DOES NOT INVOLVE him making a speech sound isnotgoingtohelphimlearntotalk. This means that all the blowing, sucking, tongue exercises, and lip games you’ve been doing will not do one bit of good when it comes to helping him produce clearer speech. OUCH!

Now I can’t say that I’m an SLP who has over-relied on this kind of stuff. I’m a talker, and I push functional communication whether it be with signs or words in play practically every minute of the time I provide direct treatment to a child. I hardly spend any time doing oral motor stuff in sessions because, frankly, I feel like my time is better spent doing “REAL” therapy stuff, and in my opinion, that’s language-language-language.

I do not write goals that say, “Johnny will perform 10-15 repetitions of oral motor exercises to improve strength and coordination for intelligible speech.” I do not make claims that these kinds of activities will “improve muscle tone,” but I know lots of SLPs who do and who base their whole treatment plan around these kinds of goals and strategies for non-verbal children and for children who are struggling with speech intelligibility.

I’d like to say that I haven’t done lots of oral motor activities in sessions because it didn’t make sense to me clinically. But the truth is, it’s because I hadn’t found a way to make them fun enough to do on a consistent basis or for any length of time. Because of this, it never really felt right or worth pursuing for me, or especially for a kid.

Besides – have you ever really tried to get a 2 or 3 year old to do these kinds of things for more than a minute or two? You might have an initial novel period where they sit with you and try to do it, but unless you make it super fun and whacky, I’ve found it wasn’t successful for very long. It’s usually pretty hard for them to do, and again, it’s usually pretty boring.

BUT I have routinely recommended, out of some kind of SLP obligation, at least in my initial assessments, that mom and dad do these kinds of things with my little clients as part of “homework.” I have even recommended these kinds of things for kids without low muscle tone or who don’t have sensory issues that are negatively affecting feeding. Why? Because it’s somehow ingrained in how we’ve been trained as SLPs. There are whole catalogues, entire textbooks, countless treatment manuals, and week-end long continuing education courses devoted to telling us how effective these are and how to do these.

As a matter of fact, Dr. Lof cited that 85% of SLPs in America who were surveyed said they use non-speech oral motor exercises to change speech sound production. Results were the same for Canadian SLPs. He cited other interesting statistics including the most frequently used exercises, the reported benefits, and the diagnoses of children when these kinds of exercises were used.

I will tell you that every “diagnosis” for kids I see were on that list including dysarthria (which is unintelligible speech due to low muscle tone), childhood apraxia of speech, structural anomalies (probably cleft lip/palate but not specified), Down Syndrome, enrollment in early intervention, late talker diagnosis, phonological impairment, hearing impairment, and functional misarticulations (meaning sound substitutions). This tells us that MOST SLPs are recommending this kind of task for MOST clients that they see – even toddlers enrolled in early intervention programs.

His conclusion, again based on a number of studies, was that it’s notappropriate for any of them. Double OUCH!

Again, I don’t feel too badly on a personal level since I haven’t used them all that much, but I feel super sad about all of the therapists who have and mostly for the moms they’ve convinced to try to do it.

In this presentation, he also dissected most arguments for using oral motor exercises including that children must first learn to produce isolated movements before they can use a speech sound, that you have to build up articulatory strength when a child has low tone, that these exercises “warm up” the mouth before talking, and that you have to have adequate coordination in non-speech exercises before you talk. He debunked every one of these very persuasive arguments for non-speech exercises with 10 different studies that prove otherwise. His conclusion was that no research supports the use of these for any reason when improving speech is the goal. Triple?OUCH!

His bottom line was this –

“If clinicians want speech to improve, they must work on speech, and not on things that LOOK like they are working on speech.” (GOOD! To learn to talk, you must focus on talking and not blowing, wagging, puffing, etc…!)

“Phonetic placement cues that have been used in traditional speech therapy are NOT the same as non-speech oral motor exercises.” (GOOD! This means you can and should still give your child verbal, visual, and tactile cues about placement of his tongue or lips to help him make a speech sound correctly. The difference here is that you’re actually working on SPEECH and not just a movement.)

“Non-speech Oral Motor Exercises are a procedure and not a goal. The goal of speech therapy is NOT to produce a tongue wag, to have strong articulators, to puff out the cheeks, etc… Rather the goal is to produce intelligible speech.” (GOOD! Goals must have speech and language outcomes. That’s a big duh to me, but again, these never made much sense to me anyway.)

“Speech is special and unlike other motor movements.” (GOOD! He means that using these kinds of exercises to improve feeding do not necessarily correlate to the same movements needed for speech. He cites studies that prove that same function/same structure argument doesn’t hold water. He also means that working on a particular oral exercise like lifting your tongue up and down 10 times in a row may not translate into a kid being able to lift up his tongue to produce a sound like /l/ when saying a word or in a phrase. No kiddin’! I gave up that kind of assumption early into my?2nd year of work when this rarely produced results!)

This last one really gives a kick in the seat of the pants to SLPs who depend on oral motor exercises as a staple in their treatment plans –

“Following the guidelines of evidence-based practice, evidence needs to guild treatment decisions.” (Here’s his parting blow – ) “PARENTS NEED TO BE INFORMED THAT NON-SPEECH ORAL MOTOR EXERCISES HAVENOT BEEN SHOWN TO BE EFFECTIVE AND THEIR USE MUST BE CONSIDERED EXPERIMENTAL.” (Emphasis was mine, not his.)

My bottom line is this – I won’t be recommending or doing these in therapy anymore for kids whose focus is speech and language, and now not just because young children?don’t like them and won’t do them,?but because science tells me not to bother. Whew! Laura

Here’s the original article’s reference for those of you who want to read it yourself –

http://www.speech-language-therapy.com/Lof-2006-ASHA-06-Handout.pdf

Other articles from experts who’ve looked at the same issues & reached the same conclusion –

In the spirit of fairness, here are?articles that?disagree with Dr. Lof’s findings –

http://www.speech-language-therapy.com/oral-motor-TT-bathel.pdf

http://www.speech-language-therapy.com/williamsetalACQ2006.pdf

One more thing – Another SLP also cited Dr. Lof’s article and arrived at this conclusion which I also agree with –

“Oral Motor therapy does have its uses. While it is ineffective for improving speech production it is effective for treating many issues related to feeding. And that is an important distinction. If your child is drooling, or unable to move food around with his tongue and chew, Oral Motor Therapy can be very effective if provided by a competent therapist.”http://www.speechlanguagefeeding.com/Newsletter.html

Comments

Thank you for posting this. My son Joshua was diagnosed with low oral muscle tone, and while we do exercises with him, such as blowing, sucking on straws, and chewing Skittles, I was confused as to why these won’t really help with his speech. His therapist said she read it, but coulnd’t remember the site. Thank you for breaking it down into plain English, so people like me can understand it!

Amy – I felt like I needed to address it because it’s come up so much lately in discussions with my own clients. Hope it’s helpful to you and your SLP and any other moms you might know who could benefit from the info! Laura

Part of the controversy is the quality of the exercises and matching the exercises to the child’s weaknesses relative to feeding. Then applying this to speech sound productions where the child does produce sound will make a difference. Some of our prior techniques & measurements in our field have been poor. New information about what does work and for whom is coming out. Don’t throw the baby out with the bathwater! Still dedicated after more than 30 years, Sharon
See http://www.oralmotorinstitute.org

Laura,
THANK YOU!!! I am an SLP and it’s so frustrating to try and constantly explain to parents how/why oral motor exercises are not proven to be effective treatment. Sadly there is so much commercialism of products out there promoting oral motor treatment that it’s very much out there for parents who “google.” And many clinicians just do what they see but don’t have the time to investigate the evidence on why/how it works. Thanks again for putting the evidence out there 🙂

Sharon – Thank you so much for your input. I know that there are lots of SLPs who agree with you, but the research is stacking up against it, so someone better hurry up and start designing better studies to prove that non-speech oral motor exercises really do work to improve speech production!

Dr. Lof, the author of the study I referenced, was kind enough to directly send me his follow-up ASHA presentation in 2007, after reading my post here on the site. The 2007 paper contained even more studies that refuted the effectiveness of oral motor exercises to improve speech sound production. He also told me of new research that’s coming out in December in the ASHA journals, so it will be interesting reading for our field.

I think a little debate makes us all better because it challenges us to examine why we do what we do and the effectiveness of it. Frankly, if what I’m doing doesn’t work, I do want to figure it out so that I can move on to something that will work. In the end, that’s the best any of us can do for our clients and their families. Thanks again for your input! Laura

Kerrie – Thanks for your comment! But as you can see from the other recent comment from Sharon, this is controversial in our field! How it all shakes out will be very, very interesting for us! We are going to talk about this in this Friday’s (September 5) show, so I’d LOVE for you to call and chat with me about this! Join us if you can! Laura

I actually disagree with your statemeent regarding oral motor exrecises. I am a SLP in a hospital based setting. Though I agree with your statemnet that functional communication activities are best, teaching non verbal activities such as blowing and lip rounding help articulation as well as increase strength. This may be YOUR way of practice but you are having other parents read this and then discredit what tons of speech therapist use in their sessions. Just because you do not use it in your sessions does not mean it does not work.

Jill – I totally acknowledged that I have used oral motor exercises with my population of children – toddlers in early intervention – and that I felt they were very limited in results and effectiveness with my particular population. We are probably comparing apples and oranges since you’re in a hospital-based practice and likely don’t see toddlers. Even then, you are certainly entitled to do whatever you want to do with the children you see, regardless of what is written here or anywhere else.

But I want to urge you to please re-read the article again because it’s not my opinion. This time you may want to check out the link to the original reference article. It’s based on a paper submitted by a PhD level SLP for ASHA in 2006 and again in 2007. Dr. Lof compiled many, many research studies about the effectiveness of non-speech oral motor exercises to target speech sound production. The results are staggeringly opposed to using non-speech oral motor exercises to target improved speech sound production. In the later study, he also looked at other methods, such as using traditional speech sound production cues (such as cueing a sound with a hand motion or tactile cue) or even a more complex treatment methodology like PROMPT, which uses both visual and tactile cues to teach sounds, and both of these methods, are NOT included in this category and therefore ARE scientifically effective with research to back it up), since these methods actually do target speech sounds in conjuction with an oral motor movement. According to the 2 dozen or more studies cited by Dr. Lof, RESEARCH (not me) tells us that using non-speech oral motor exercises to improve speech sound production cannot be proven in a clinical study.

Again, none of this was my idea or opinion. I am soooooo not a researcher, just a clinician who is looking for better ways to do things and more importantly, better ways to teach parents to do things. Your complaint is with the science, sister – not me.

You may turn out to be right, and at that point, I’ll change what I do again. Another SLP wrote in that new research is coming out to prove that these exercises do work, so we will see. If and when that data comes out, I’ll start blowing and sucking and wagging again, but until then, I’m not, and I won’t feel guilty about it. Do what you want to until then, or after for that matter. Sorry I got you all worked up. Laura

P.S. I have tried to post a link to the 2007 follow-up paper, but Dr. Lof sent it to me via a pdf file, and it’s not posted on the internet to my knowledge. If you’re interested, I’ll forward it on to you. He also gave me other references, and I’ll be glad to forward those as well.

I’m a dad doing some research on the oral motor topic. After reading your article I have some questions:

1. You state that exercises that strengthen the “oral muscles” have no effect on speech production. That doesn’t make sense to me. Especially since you added that they ARE effective for feeding issues. If strengthening those muscles will help improve moving food around in the mouth as well as chewing why wouldn’t they help a child use those muscles to make sounds?

To me it’s like saying, building your leg muscles will improve your running, but it won’t help improve your ability to hop.

2. The oral muscles are used for speaking.
So, why wouldn’t improving those muscles help improve speaking? This I don’t understand. Improving the strength and stamina of all other muscles in the body help improve direct AND INDIRECT functions of those muscles – walking, throwing, bending, reaching, etc.

Ben – Thanks so much for your questions! These are the same questions we SLPs are asking when looking at this research. As you can tell by some of the comments I’ve gotten from professionals, this is such a hot topic for us, so join the club!

I want to encourage you to read Dr. Lof’s original article yourself since he answered your questions in it, and the link is the first one that’s provided as a reference in my article. However, I’ll try to rearticulate his points.

The studies Dr. Lof cited can find no statistical difference in speech sound productions when children do non-speech oral motor exercises and when they don’t. The researchers concluded that –

1. It doesn’t really take that much “strength” to speak, so doing lots of exercises MAY make the structures stronger, but there’s NO statistical carry-over to clearer speech. Speech intelligility seems to be more dependent on agility and coordination than strength. Oral motor strength DOES seem to impact feeding, according to the research. (Again – please read it for yourself for specifics.)

One other thing I found fascinating about training muscles (say like for running, etc….) is that you exercise the muscle to the point of fatigue and then some, to make real gains in strength. This is usually not the case when using non-speech oral motor exercises using protocols or directions an SLP would typically give a child during speech therapy. So to use an exercise metaphor really is comparing apples to oranges.

2. The other point Dr. Lof makes so much more clearly than I can is that just because it’s the same structure doesn’t mean that it’s the same function. The example he gave that made the most sense to me and the parents that I’ve discussed this with was this – piano teachers don’t teach you to play the piano by hitting your fingers on a table. The movement of your fingers is the same, so why wouldn’t this work? The piano teacher is also working on melody, phrasing, dynamics, etc… not just the tapping movement required to push the keys.

I’ve used also this example with parents – would you simply do exercises in the gym to train for a marathon and hope you were ready because you made your legs stronger, or would you actually have to get out and put your feet to the pavement? You have to practice using the same mechanism AND the same function, so to talk, you need to practice using your mouth muscles during speech to get the effects you want.

Again – this is for NON-SPEECH oral motor exercises. Using the same movements you do in speech WITH VOICE seems to be the difference here. It’s the no voice/no speech sounds with an exercise that’s not recommended, according to current research.

I hope this information helps, and again, PLEASE, PLEASE, PLEASE read the original research for yourself, because Dr. Lof addressed these questions much more thoroughly than I did (and can for that matter!)

Dr. Lof e-mailed me after someone told him about this article on my site and was gracious enough to offer to respond to any specific questions from readers. I have forwarded your questions to him, so if I’ve not answered your questions, I hope he can.

Thanks again for your questions! You’re such a great dad for investigating methodology in order to help your child! I applaud your efforts! Laura

Because I have not seen the specific child that this father is writing about, I will only briefly talk about two topics that he brought up: strength needs/strengthening the articulations and “task specificity.”

For talking, very little strength is needed to talk (about 10-15% of what the articulators can maximally do). This means that strength is usually not the problem with poor speech. But IF you were trying to strengthen the articulators, you would have to force the child to follow the basic strength enhancing paradigm that is used for all muscles: multiple repetitions (many many many movements), against resistance (some kind of “weights”), until fatigue. Think how much it takes to strengthen the biceps when someone works out at the gym. The same exercise regimen would have to be done with the mouth. I doubt that most nonspeech oral motor exercises follow this routine. Besides, there is evidence that children with speech sound disorders may actually have STRONGER tongues than do children without speech problems. I hope no one would try to weaken these strong articulators in the hope to improve speech!

There is a large body of evidence that proves that nonspeech movements and speech movements are different. Neuroimaging studies have demonstrated that different parts of the brain are used for talking movements than for nontalking movements. The brain seems to be wired for the task, not for the specific articulator. This is what is meant by “task specificity”: the brain represents movements for the task, not organized for specific muscles. This is why feeding (nonspeech) is different from movements for talking. The evidence on how “speech is special” and unlike other movements is well known in the speech-language pathology and oral physiology literature. Remember, speaking is a cognitive, linguistic, motor act…not just a motor act. This is what makes movements for speaking and nonspeaking so different.

These topics and others related to nonspeech exercises are more fully expanded upon in the July 2008 issue of the professional journal Language, Speech and Hearing Services in the Schools. I encourage speech-language pathologists (and parents) to read them. My take-home message is: if you want speech to change, work on speech.

Anon – Adding the sound makes it a speech oral motor task, and this is what the research says works to help speech become clearer. Doing the movement repetitively without sound is what is not recommended according to the current research. Thanks for the question – Laura

Ok so doing the excercises before putting sounds to them is what the study says doesn’t work with apraxic kids…..which means the study doesn’t agree with the fact that you can ‘train’ the muscles to do the movements then right? I had someone tell me their spouse who’s a basketball coach actually have their team do the ‘practices’ like the study talks about to practice their game. Very interesting. Thanks for the clarification 🙂

Anon – Yesterday I should have said adding the “WORD” instead of adding the “sound” is what sets these oral motor exercises apart since children need to practice using words to learn how to talk. Sorry if I caused any confusion here in my haste to respond to you!

I also should have addressed your second comment concerning apraxia in kids and oral motor exercises yesterday, but Dr. Lof has beat me to it! His comments to me are included in my new article about oral motor exercises with kids with apraxia. Look for it on the home page.

As far as using the basketball analogy, I’d try to think about speech in a different way if I were you. Take a look at Dr. Lof’s previous responses again for further, and more technical, clarification.

For most parents understanding that “Speech is different” or “Speech is special” should become our mantra so that we don’t get caught up in trying to make any other exercise analogy fit for explaining treatment for a speech delay. The neuroscience tells us that where speech is concerned, our brains don’t work like that. To use other motor activities to try to understand the complexity of speech production is really comparing apples to oranges.

Again – sorry I misspoke/mistyped and confused anyone! And special thanks to Dr. Lof who keeps lending us his expertise in this area! Laura

Robin – I have read Jennifer Bathel’s response, but thanks for pointing that out to our readers.

I am not opposed to oral motor exercises for kids who need to target this for feeding skills and for those who have such extremely low oral muscle tone and/or poor oral-sensory awareness (i.e. still drooling waaaaay past turning 2 because of a lack of awareness).

BUT I think the research is pretty compelling for thinking twice about doing oral motor exercises “rotely” with the guise of improving speech intelligibility for the majority of children where muscle tone has had no other negative functional impact (i.e. no feeding problems, no drooling, etc….).

Thanks for expressing your opinion on what continues to be a topic of discussion in our field.

Thanks for the great forum! I am an slp who, years ago, was hooked on oral motor therapy and believed whole-heartedly. Until, a wonderful CFY speech therapist taught me, “Sucking and blowing helps sucking and blowing”. Because she was my student, I wanted to show her how the oral motor exercises were working, but, try as I might, I realized I couldn’t. SO what if a child could now blow a whistle that he couldn’t a month ago, maybe it was practice, growth, learning how to blow. I searched for norms of what is typical oral motor strength for a child 12 months, 24, 36, and came up with nothing. THe light began to shine!

I continue to use my oral motor toys for sensory stimulation and “increasing oral movement”, and always pair oral motor play with speech sounds or vocalization. At times, it can help some kids learn how to posture their mouth for “oo”, blowing a whistle and then saying “oo”. Doesn’t work for everyone.

WIth my feeding work, I always have food on the oral motor toys. If we are doing “chewing exs”, instead of using a NUK brush with no food, I use actual food in a toddler safety bag. Its a whole different story when there’s flavor and texture to manage when eating, its NOT just a motor process.

I am familiar with Dr. Lof, he’s great. I just don’t understand why people are still doing this oral motor stuff without evidence based data. Why doesn’t ASHA do something? Public agencies continue to fund this therapy, based upon anecdotes. What upsets me the most is the false hope it gives parents.

BUt, this is the US of A, and someone is making a lot of money off of these kids. The sad part. It is our responsibility to practice evidence based and researched methods. This forum should help more people do so. THanks Again! donna

Thanks Donna! There are lots of SLPs who are die-hards about oral motor, but unless they, like you, start looking for black and white results as well as data to support what they’re doing, will likely go to their graves blowing, sucking, puckering, and lateralizing!!! Thanks for the positive comments about the articles. Other SLPs have not been as kind… Laura

Thanks for the forum, its really helped me find the information I need to start to understand this area better for my practice.

If you haven’t already, please read the information on the oral institute pages http://www.oralmotorinstitute.org that Sharon refers to. This encourages us to consider each aspect of oral motor intervention carefully in the context of different clients with different needs. To say there is no place for ANY oral motor exercises with ANY of our clients would make our job very difficult. For example:

-Consider a 15mth old child with cerebral palsy who has low tone and can only produce open vowel sounds. How can we teach this child to produce bilabials without using ORAL MOTOR TECHNIQUES to improve his lip tone and to teach him how he can use his lips to produce the sound.

-Consider an 18mth old child who has a good range of sounds, and attempts words all the time, but his production of words vary with each attempt with no pattern of substitutions (i.e. as we might see with dyspraxia). How are we to teach this child to produce /b/ words with a consistent /b/ sound without giving him a means of visual or tactile cuing which stimulates accurate movement of the lips to consistently produce the target sound. A child may take some time to coordinate lip movement, with phonation to produce a consistent bilabial, but only when he has mastered this, can we teach him to use that sound consistently in words. This again is an ORAL MOTOR TECHNIQUE.

-Consider a 4 year old who is fronting his velars, how do we show him that he needs to use the back of his tongue, rather than the front, without using ORAL MOTOR TECHNIQUES to show him how to raise the back of the back of the tongue and keep the tongue tip low.

-Consider an 8yr old with cerebral palsy who can mantain clear speech during a short sentence, but becomes faitgued during conversation and reverts to slow and imprecise articulation. How can we improve this child’s endurance without using ORAL MOTOR TECHNIQUES to improve strength.

I would be interested to hear from anyone who has treatment approaches to the above examples that do not rely on Oral Motor Techniques.

I think that it would be easy to take presentations such as gregory Lof’s out of context and disregard all aspects of ORAL MOTOR TECHNIQUES, I’d like to think what he intends to say to use is don’t do specific “Non-Speech Oral Motor Exercises” for the sake of it, without a good reason. I would like to think that he is not excluding any and every oral motor technique. And yes there is a lack of good research, and we desperately need more across the board in Speech and Language Therapy, but until then we should be using our knowledge, good judgement and experience to guide our approach (see http://www.speech-language-therapy.com/williamsetalACQ2006.pdf)

Catherine – Thanks for your thoughtful post. Let me say that I do agree that specific children need specific treatment plans to target their own individual deficits. I think what you’re describing for each specific situation sounds clincally appropriate because in each situation, you’ve justified WHY you’d want to use an oral motor technique. I also agree with you in thinking that Dr. Lof’s point is that just to do tongue lateralizations or blowing and sucking without a specific sound goal or outcome in mind is not what we need to do.

Also keep in mind that this site is for parents of very young children. I firmly believe that language should be the key focus for treatment plans for even the kinds of toddlers you described, with speech as a secondary focus. Please know that in my practice I also use lots of cues (verbal, visual, & tactile) when I work with toddlers to achieve accurate sound production and then as quickly as possible try to move that sound into words. What I don’t do is routinely recommend or perform oral motor exercises unless I have a very good reason for it, and I certainly don’t include it as a “blanket” approach when I think about and write treatment plans.

I’m thrilled this series of articles caused you to re-evaluate your own individual practices with clients. Your families are lucky to have you! Laura

As a parent who was just told my 20 month old son is not speaking due to tongue weakness and was given a plan with in 6 months my child will speak 10-12 words, I am concerned after reading all of this. I was concerned before when I was not given a prognosis for how well he would be able to “catch up.” What are effective therapies? What is the sucess rate of therapy for children with only speech delay with no other concurrent problems?

Jill – Thanks for your questions. I know you’re probably sick of hearing “every child is different,” but there’s really no crystal ball in predicting exactly how well a child is going to do, and especially when I can’t see him!! However, you have 2 really good prognostic indicators on your side here – he’s only 20 months old and you’ve already started therapy AND he doesn’t have any other identified issues. The research tells us that children who participate in early intervention services have a much higher percentage of “catching up” than those who don’t get services until much later (or not at all). So I’d like to pat you on the back first of all, for identifying his delay so early, and secondly, for seeking further information to help him.

Let me also throw in another little piece of advice for what it’s worth. I’d still encourage you to be very, very playful with him and still focus primarily on LANGUAGE rather than on things like oral motor exercises for him. For all toddlers, if it’s not FUN, they’re not going to want to participate. For ideas on how to make that happen, you may want to check out my DVD Teach Me To Talk. I’d also strongly recommend implementing signs so that he has a way to communicate his wants and needs while you’re still working out all of that speech stuff. Good luck and let us know how he progresses!! Laura

I am shocked by the opinion in this article being so adamant. I have my doctorate in Physical Therapy and an undergraduate degree in Exercise Physiology. I have had my share of research and evidence base treatment critiques. I also have a son with autism who has attended endless totally ineffective Speech Therapy appointments for 3 years. It was not until his ABA consultant with a dual degree as an SLP started doing Oral motor exercises. ( I heard recently that name is changing, not referred to as oral motor). Anyways, What causes the movement that produces the sounds ( besides the lungs) is neural and muscle synergies. To say that you can teach a child with autism to articulate better by repeating sounds or better yet telling him/her to put their tongue somewhere is ridiculous, I have seen these techniques tried myself for years. IT was not until recently when I did my own research into strengthening of his facial muscles which is how we would approach it in the field of Physical Therapy and do for our facial patients, ie bells palsy. These patients have great outcomes with our treatments. My son likely has dysarthria, and the recent increase in his jaw stabilization exercises and facial strengthening exercises has significantly increased his ability to articulate sounds that 4 SLPs in the past 4 years have had no impact on, and just frustrated him in the process. Any parent reading this, please do not “throw the bay out with the bath water”. Yes he practices language all day long, but he has significant progress with his language while he does his oral motor program. Please parents….Continue to pursue good oral motor therapy to incorporate into your language therapy program

Cynthia – Thanks for your sharing your opinion, and I’m so glad your son has seen success with his speech as a result of these exercises. No one can argue with you about that.
However, the studies I referenced in the article with the subsequent discussion by Dr. Lof, outlined the reasons that many SLPs (not just me!) are questioning the effectiveness of oral exercises. I do know there are lots of SLPs working on studies to provide their efficacy, so in time we’ll see.
Until then I’d also encourage any parent and professional to understand why we’re including any specific strategy or treatment modality in a child’s plan. If there’s sound justification (as it sounds like there is since your son is likely dysarthric), and certainly when you’re seeing progress, by all means continue to do what’s working and move on to try new things when you’re not seeing progress.
Again, thanks for your contribution. Laura

I’m an SLP and I totally agree with you, Laura, about your original post re: oral motor exercises. I have a 3.5 yr old client who drools a lot, constantly has a wet mouth, and is unaware of his drooling. He’s done his share of blowers, bubbles, whistles, etc. I am not such a fan of working on non-speech activities for all the reasons you cited (well, Dr. Lof, cited), but at the same time, I’m not sure how exactly to treat this child’s excessive drooling and open mouth posture without invoking oral motor exercises (which haven’t exactly worked for him, so it’s kind of a catch-22). He is receptively and cognitively aware, and his expressive language is sometimes unclear, and I feel a lot of that is because he always has a wet mouth or is in need of swallowing saliva. Any ideas on what might help this child?

Stephanie – Thanks for your comment. Dr. Lof’s article was really related to speech sound production, and it sounds like the thing you’re most concerned about is drooling.

With these kinds of kids, I always initially try to rule out any medical issue which predisposes a child to mouth breathe. If a child is chronically congested, he is going to have an open mouth posture since he is likely not breathing efficiently through his nose.

You’re also going to have to do a fair amount of sensory work on his face and mouth since he’s unaware of the wetness and drooling. You’ll have to start by helping him understand and contrast wet vs. dry, and since you say he’s cognitively aware, this increased awareness and focus may go a long way toward helping him “get it.”

Does he respond to verbal cues to “swallow” or wipe his wet mouth? I’d implement those things immediately. Some parents don’t like teaching a kid to wipe his mouth on his sleeve, but I really think it’s the most practical, especially for a 3 year old. Once he’s wiping consistently, then try a more subtle cue like, “Is your mouth wet?”

I do think there are more complex programs and ideas out there for treating drooling. I believe Pamella Marshella has a short book about this, and I’d track this down for other ideas. She does do lots of oral motor/sensory work too, but I believe what you’re talking about is essentially different than working with a child with only speech production/intelligibility goals since your guy has other oral motor problems as well. Good luck and thanks again for your question 🙂 Laura

I’ve had my child in speech therapy for 4 years no progress. He is nonverbal autistic, he has been with 5 different speech therapist with no progress. I’m going to try mouth exercise, after all, what do I have to lose – he isn’t talking now maybe this is the key to his talking. I’ll stand on my head if that would help.

Terri – I’m so sorry your child is having such difficulty learning to communicate, and I know this must be heart-breaking for you. At this point, I’d try anything too!

How are his social skills and language comprehension skills? Is he gesturing at all? Those skills are foundational prerequistes for communication. Is he able to use signs or PECS? Since speech has been so difficult for him, I hope you all are using some alternative methods.

Thanks so much for your comments, and I wish you guys the best of luck in finding something that will be successful for him. Laura

Hi Laura,
I have read your interesting article and the posts that it provoked. My son is 2.10 months old, he combines words and follows commands well, but it is VERY hard to understand him, specially to outsiders. His SLP began working on his language skills (he wasnt speaking when she started working with him) but now says we need to move on to oral motor therapy to improve his inteligibility. My son has open mouth posture and his tongue is always low and peeking out. Is this appropriate? What exercises would you recommend? What questions should i ask my SLP to see if she is up to date on this topic? Thanks!

Sue – It does sound like he has low muscle tone, and in this situation, it may be worth giving the oral motor therapy a try. Talk with your SLP about it. She can see him and has worked with him, so if you’ve been happy with your results with therapy so far, I wouldn’t stop trusting her now 🙂 Laura

Hi Laura, thanks for a fascinating read and thanks to every one else for the follow up discussion. I’m an SLP (SLT in UK where I am) and this has helped confirm what 15 years practise has taught me, ie communication is so much more than a motor act. I gave up on oro-motor stuff a long time ago as didn’t see any benefits and had to stop offering false hope (in my view) to children and parents. Working mostly with children with CP and other neurological conditions I’ve found that focusing on vowels (and AAC) for dysarthria and/or muscles for feeding/drooling work best and keep it all functional and fun.
If you want to play better tennis get a racket not a Wii.
Thanks again,
Mark

Hi Laura,
It’s been fascinating reading this discussion. I’m an SLP working with the early intervention population (1 – 3 yr olds). I never got into oral motor therapy myself, and I would say 80% of my speech delayed clients reached maximum success with focusing on language. The remaining 20% were the kids who had Autism and had more modest improvements and then there were the occasional kids who had no diagnosis and seemed normal all around, but did not attain any verbal imitation skills. They may have had a 10 word vocabulary which they would use when they wanted to. They could follow directions and do some pointing, but not speak on demand. I was hoping that the oral motor exercises would be the key for these kids since it was something I wasn’t doing with them. What can I do for these kids who seem developmentally OK (maybe slightly less mature for their age) can comprehend, and produce some words, but lack the imitation skills needed to increase vocabulary and develop multiword phrases.
Please help!

Hi Laura,
Thanks for the information. I have spent 11 of my 19 years as SLP working with the birth to three population. Your article summed up exactly how I have felt the entire time I’ve been working with young children. I attended a seminar a few years ago at Indiana University that went into great detail regarding the research against spending valuable therapy time doing oral motor exercises to help stimulate speech development or improve speech clarity. I had never been a big proponent of oral motor activities for a variety of reasons including the difficulty getting children and their families excited about doing them. After attenting the seminar at IU and reviewing the research, I have explained to many parents my reasons for NOT doing them, because several parents have asked me about why I don’t. Even knowing what the research says, I have been tempted to try some oral motor tasks on some of the kids that have made little progress otherwise, especially kids that just don’t seem to move their mouth much at all (I’ve has several kids like this). My rational for having kids do these types of acticities (blowing bubbles, smacking lips, tongue wagging…) has been that it may help them become more aware of their oral structures and aid in them being able to take instruction regarding tongue placement, etc. when they are a little older. I don’t typically spend therapy time doing theses, but give instruction to parents to do them with teir children. What do you think about this? Is it still a waste of time? By the way, a couple of the kids I’m thinking about do NOT have eating problems. Thanks for any input, and also for confirming my beliefs on this topic.

Rose and Shelley – Thanks for your recent contributions to this continued discussion about pros and cons of oral motor exercises for our youngest clients. Shelley – I too continue to have children try to blow bubbles, but for me, it’s to have them learn to imitate mouth movements, which for some children is an important precursor to imitating words. It’s not for strengthening, or to improve mobility, or any other reason than learning to imitate which is CRUCIAL in learning to talk! Thanks so much for your input, and stay tuned! I’m sure this isn’t the last we’ve heard about this topic!! Laura

I have a 3 year old child with a cochlear implant. She can not seem to build the intra oral pressure to make SHH / SSS sounds. She just blows and spits. Any ideas on excercises? I have done blowing horns just as an alertness/warm up of articulators. ANY SUGGESTONS????

My son turned three in March and his doctor told us he has delayed speech, so I looked in the phone book for SLP’s and there is only one for our area. Is the pre-school program going to be enuff for him? If I can afford the SLP I will do it and I will make sure to ask if her emphasis is on exersizes or actual speech. This report was helpful! Thank you

Sarah – If his doctor has identified delayed speech, then you do need to see a speech-language pathologist. Try your local public school system for a full speech evaluations. You can find their info in the phone book as well. Laura

About

Laura Mize is a pediatric speech-language pathologist who specializes in treating young children, ages birth to three, with communication delays and disorders in her private practice in and around Louisville, Kentucky. She earned a B.S. in … [Read More...]